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Advocacy Post Service Survey

Please fill out the form below or print the PDF and submit.

Please read all instructions carefully and complete all sections of this form completely and accurately.

The Arc of Northeastern Pennsylvania welcomes your comments to help us better serve you. Please complete the survey on advocacy services. Thank you!
I sought The Arc's Advocacy service for my:
School age child Adult Relative Senior Citizen Self
Other (please specify)
Please check the age group for the individual for whom advocacy services were sought.
Youth pre K (0-4 years old) Youth School Age (5-21 years old)
Adults (21-59 years old) Senior (60 plus years old)
In what ZIP code is your home located? (enter 5-digit ZIP code; for example, 00544 or 94305)

My primary goal in contacting The Arc for Advocacy support was:

My goal in working with The Arc Advocate was met.
Strongly agree Agree Neutral Disagree Strongly Disagree N/A
Other (please specify)
My knowledge has improved since working with the Advocate.
Strongly agree Agree Neutral Disagree Strongly Disagree N/A
Other (please specify)
Response time to my request for service was;
Same day Within 2 days Within one week More then one week
Other (please specify)
The Advocate was knowledgeable.
Strongly agree Agree Neutral Disagree Strongly Disagree N/A
Other (please specify)
I am satisfied with the assistance provided by The Arc's Advocacy Service.
Strongly agree Agree Neutral Disagree Strongly Disagree N/A
Other (please specify)
I would recommend The Arc's Advocacy Service to others.
Strongly agree Agree Neutral Disagree Strongly Disagree N/A
Other (please specify)
Optional
Name:
Company:
Address:
Address 2:
City/Town:
State/Province:
Zip/Postal Code:
Country:
Email Address:
Phone Number: